POS1403 CLINICAL CHARACTERISTICS, HEALTH CARE RESOURCE UTILIZATION, AND COSTS ASSOCIATED WITH FLARES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN GERMANY
Authors: B. Ding, M. Pignot, E. Garal-Pantaler, B. Villinger, B. Desta, K. Schmidt, S. Golam, H. Stirnadel-Farrant, A. Schwarting
Journal: Annals of the Rheumatic Diseases (2022)

Background Longitudinal data describing real-world systemic lupus erythematosus (SLE) disease characteristics, health care resource utilization (HCRU), and costs associated with flares in Germany are limited. Objectives To evaluate the clinical characteristics of patients with SLE and estimate the impact of flares on HCRU and costs in a cohort of adults with SLE in Germany. Methods CHaracteristics and impact of flares on clinicAl and econoMic OutcoMes In patients with systemic Lupus Erythematosus: a German Claims Database Study (CHAMOMILE) was an observational, retrospective cohort study. Adult patients with SLE were identified from the German Betriebskrankenkassen health insurance fund database between 1 July 2010 and 31 December 2013, and followed for up to 9 years. Baseline period was defined as the first year since the first quarter with the earliest SLE diagnosis during the identification period, including this quarter. Resource utilization measures included number of hospitalizations, duration of stay, and associated costs per person-year (PY) by follow-up year for patient subgroups defined by flare exposure (no, mild, or moderate/severe flares) during baseline. Cost measures included total PY costs in flare-exposure subgroups. Results Of 2088 patients included in the study, the mean (SD) age was 51.4 (16.1) years and 1767 (84.6%) were female. The most common SLE manifestations were cutaneous (66.8%), osteoarticular (28.7%), and vascular (23.0%). Patients were receiving treatment with glucocorticoids (54.8%), antimalarials (40.2%), nonsteroidal anti-inflammatory drugs (39.1%), and/or immunosuppressants (32.7%). During the baseline period, 750 patients (35.9%) experienced moderate/severe flares, 622 (29.8%) experienced mild flares, and 716 (34.3%) experienced no flares. Patients with no flares or mild flares during the baseline period had similar costs, and a similar number and duration of hospital stays per PY, which remained consistent from baseline up to 9 years of follow-up. Patients with moderate/severe flares during the baseline period had 2- to 3-fold higher hospital costs, 1- to 2-fold more hospital stays, and hospital stays that were 2-fold longer in duration, compared with the no-flares or mild-flares groups during baseline and each year of follow-up (Table 1). During the baseline period, annual total costs were more than 2-fold greater for patients with moderate/severe flares (€11,048/PY) than patients with mild (€5148/PY) or no flares (€4734/PY). In all subsequent years, costs for patients with moderate/severe flares exceeded costs for patients with mild or no flares. Annual total costs gradually increased over time to €7761/PY for patients with mild and to €7564/PY for patients with no flares at Year 9, whereas costs reduced sharply at follow-up Year 1 to €8801/PY and remained similar to Year 9 for patients with moderate/severe flares (Figure 1). Table 1. Mean Costs, Number, and Duration of Hospital Stays per Person-Year by Baseline Flares Flare-Exposure Subgroup Year Baseline 1 2 3 4 5 6 7 8 9 Patients, n No 716 716 701 676 658 634 603 526 444 315 Mild 622 622 613 596 575 559 534 455 348 239 Moderate/severe 750 750 721 690 669 646 624 503 391 263 Costs of hospital stays, mean, € No 1325 1798 2296 1725 2233 3126 1759 1786 1795 2047 Mild 1779 1944 1545 1820 1652 2261 2390 1974 2290 2451 Moderate/severe 5517 3550 3403 2798 2725 2999 2663 3695 2714 2977 Number of hospital stays, mean, n No 0.49 0.46 0.47 0.44 0.51 0.53 0.44 0.41 0.44 0.45 Mild 0.46 0.48 0.40 0.50 0.42 0.47 0.47 0.48 0.51 0.43 Moderate/severe 1.39 0.85 0.76 0.64 0.62 0.67 0.63 0.76 0.60 0.74 Duration of hospital stays, mean, days No 3.51 4.66 4.98 3.91 5.02 5.41 3.98 4.58 4.46 4.73 Mild 4.55 4.91 4.11 4.41 3.76 4.33 4.13 4.05 4.68 4.19 Moderate/severe 13.89 8.18 7.58 7.68 6.88 7.10 6.59 7.89 6.54 6.03 Conclusion Patients with moderate or severe flares following diagnosis place a large burden on the health care system in Germany. Earlier diagnosis and treatment may reduce flare severity and the associated high health care costs. Acknowledgements Writing assistance by Rebecca S. Jones, PhD (Fishawack Health). This study was sponsored by AstraZeneca. Disclosure of Interests Bo Ding Employee of: AstraZeneca, Marc Pignot: None declared, Elena Garal-Pantaler: None declared, Beate Villinger Paid instructor for: Novartis, Vertex, Boehringer Ingelheim, UCB, Consultant of: Novartis, Vertex, Boehringer Ingelheim, UCB, AstraZeneca, Employee of: Novartis, AstraZeneca, Barnabas Desta Shareholder of: AstraZeneca, Employee of: AstraZeneca, Katharina Schmidt Employee of: AstraZeneca, Sarowar Golam Employee of: AstraZeneca, Heide Stirnadel-Farrant Shareholder of: AstraZeneca, GSK, Employee of: AstraZeneca, Andreas Schwarting Speakers bureau: AstraZeneca, Genentech, Consultant of: GSK, Astra Zeneca, Grant/research support from: GSK, Pfizer, Novartis